The Pharmaceutical Journal Vol 266 No 7150 p761
June 2, 2001

United Kingdom Drug utilisation group:
Ways to improve prescribing in primary care

Over 50 pharmacists and other health care professionals with an interest in primary care met in Birmingham on May 18 for the regional scientific meeting of the United Kingdom Drug Utilisation Group. Frances Thompson reports

How pharmacists can help prevent problems with medicine taking
Consistent care and medication reviews improve the quality of prescribing in nursing homes
Encourage appropriate use of OTC medicines

How pharmacists can help prevent problems with medicine taking

Regular medication reviews can help prevent unecessary admissions to hospital caused by problems related to prescribed drugs, said JENIFER HARDING.

Mrs Harding, the primary care pharmacist at Tipton and Regis Primary Care Group, described how she had surveyed 35 patients aged over 65 years, who had either coronary heart disease or diabetes, to find out whether they had difficulty taking their medicines.

Those who were having problems were assessed to see what the best method of helping them might be. Some of the reasons for not taking medicines are shown in Table 1.

Table 1: Non-compliance in patients aged over 65 years

Reason for not taking medicines

Number

Patient had difficulty remembering when to take tablets

over 60 per cent

Patient could not open medicine bottle

50 per cent

Patient could not read label

nearly 50 per cent

Patient could not remove tablets from blister pack

40 per cent

Patient could not hear what the doctor or pharmacist was saying

40 per cent

Others not shown in the table, included that the patient did not feel well, the patient thought that they had too many tablets, the tablets were a different colour than usual, the tablets had a different name, and the patient did not know that they needed more after the initial supply ran out. Mrs Harding commented that one man was taking his own medicines, as well as those that had been prescribed for his wife.

Mrs Harding concluded that pharmacists who conducted such reviews could work with local community pharmacists to find the best way of helping the patients concerned take their medicines correctly.

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Consistent care and medication reviews improve the quality of prescribing in nursing homes

The care of residents in nursing homes can be improved by regular visits from a specific general practitioner, with regular medication reviews by a pharmacist, rather than ad hoc visits by several GPs, according to Dr IAN WALTON from Birmingham.

Dr Walton from Horseley Heath Surgery in Tipton compared the prescribing patterns of a nursing home that was attended by one GP with those of a home visited by several. He found that “homes with several different GPs and no pharmacist have less control over prescribing and cannot sustain any changes made to prescriptions”.

Dr Walton said that he had had mixed feelings when a large nursing home had been built opposite his surgery, but he had taken on responsibility for nearly all of its residents. In the other four homes in the area, a number of GPs provided care for the residents when required, and none of the homes had a pharmacist to review medication.

The pharmacist who worked in Dr Walton’s practice had undertaken medication reviews for all of the residents and, with Dr Walton, had set up prescribing protocols. These included instituting a 28-day supply rule for all prescriptions (to prevent the issuing of 56-day prescriptions every 28 days), rationalising “as required” analgesia, and reducing the number of types of catheter, emollients, enteral feeds and dressings used. As a result, the annual spend on emollients had been reduced by 80 per cent, on catheters by 50 per cent, on enteral feeds by 25 per cent, and the cost of each dressing change by at least £1. The prescribing of drugs, such as proton pump inhibitors and hypnotics, had also declined. Dr Walton estimated the annual savings per patient to be about £300, with potential savings on dressings of about £1,000 per patient per year.

Dr Walton had assessed the service that he was providing by comparing the prescribing patterns and costs at “his” home with those at others in the area. He found that the incidence of polypharmacy, unnecessary brand prescribing and inappropriate repeat prescribing was higher in the other homes. In addition, changes that had been made to prescriptions were less likely to have been sustained, he claimed.

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Encourage appropriate use of OTC medicines

Patients tend to use over-the-counter (OTC) products in addition to prescribed drugs, rather than instead of them, said Professor COLIN BRADLEY, professor of general practice at University College, Cork, Eire.

However, the use of these medicines should be encouraged, where appropriate, as it increased the self-confidence of patients, because they became more responsible for their own health. In addition, it decreased patients’ indirect costs (such as travel expenses), and it reduced reliance on general practitioners for the treatment of minor ailments, thereby making more time available for patients with a major illness. Another advantage of encouraging patients to go to pharmacies for OTC medicines was that it enhanced the clinical role of community pharmacists. However, it did mean that pharmacists would be deprived of their dispensing fee.

When asked what effect the recent demise of retail price maintenance might have on the use of OTC medicines by patients, Professor Bradley said that lower prices would be an incentive to patients to use OTC medicines but that it was vital that the involvement of health care professionals was not diminished as a result.

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